Panic Attacks

Panic attacks - I would not wish them on my worst enemy. A panic attack is an all-consuming psycho-physiological event that fills a person with complete fear and dread. Panic attacks can feel slightly different for everyone, but below is a list of symptoms from the DSM-V:

• Palpitations, pounding heart, or accelerated heart rate
• Sweating - Trembling or shaking
• Sensations of shortness of breath or smothering
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, light-headed, or faint
• Chills or heat sensations
• Numbness or tingling sensations
• Derealization (feelings of unreality) or depersonalization (being detached from oneself)
• Fear of losing control or "going crazy"
• Fear of dying

You don’t need to have all of these symptoms for it to be considered a panic attack, just some combination of a few of them. If you have experienced this just once in your life, that’s bad enough. But if you’re having them on a consistent basis, you may be struggling with what is called Panic Attack Disorder.

What Causes a Panic Attack

Panic attacks have a few different causes. First is a phobia. A phobia is severe and intense fear of a particular object, idea or situation. One very common phobia for panic attacks is what's called agoraphobia, which is a fear of open spaces or fear of being outside. There's actually a specific diagnosis for panic attack disorder with agoraphobia, and that's for people who have agoraphobia and have panic attacks when they leave their house. But this fear could really be anything that causes a panic attack for you (dogs, spiders, heights, etc.) You can probably see that the type of fear will dictate how frequently you may have a panic attack. So, if you have a fear of jellyfish for example, but you live on land, you're probably not going to have a panic attack too often. But if you have agoraphobia then you're going to have panic attacks quite often.

A second cause can be a real-life event; meaning a situation where you are actually in immediate danger. Now, some people will just call that fear, and that's true, it is fear, but you can have that same kind of response as you would have during a panic attack. The panic attack feeling is essentially akin to an intense adrenaline boost. This is your fight or flight response. When you're in a real-life scenario, and you're in a fight or flight response, your body responds by either fighting, running away, or freezing. But if it's not in a real-life scenario, there's really nothing to do. If we're just sitting around on the couch one day, and we have a panic attack, we're not in a real-life scenario, but we're having all the symptoms you might have if you were in real danger. Technically speaking, a “panic response” in a truly dangerous situation would not be considered a panic attack because there is a legitimate reason for it. In this case you are not struggling with a psychological problem, in fact your body is responding appropriately to a dangerous stimulus. I do think it is important to recognize the similarities however, so you can make sense of exactly what is happening to your body when you are having a panic attack. Your body essentially believes it is in real danger when it is not, so it is preparing you to fight, freeze or run by pumping you with adrenaline.

Another cause of a panic attacks can be trauma; and this can sometimes be included in a PTSD diagnosis. You may have had one or multiple traumatic experiences in your live that has primed your body to be excessively prepared for danger. Your body may also be “trapped in the past,” and reliving traumatic experiences that brought on intense fear and panic. If this is the case, you may want to look into therapy that addresses the underlying trauma, as addressing the panic attack head on may not resolve the depths of your pain.

The last cause is unknown. Panic attacks can happen anywhere, at any time, for any reason. This means that often times the cure for panic attacks or panic disorder does not necessary involve uncovering some underlying fear or trauma. We may instead simply focus on addressing the symptoms of the panic attack head on.

How to Overcome Panic Attacks

One of the main reasons a panic attack can evolve into panic attack disorder is because often times after a person has one panic attack, they become so fearful of the symptoms that the begin to obsess about them. This obsession leads to checking behaviors and overanalyzing every internal feeling, which ultimately leads to more panic attacks. Or at the very least a constant underlying dread of the future. We want to avoid another one, but the act of avoiding only leads to even more misery. In this section I am going to discuss two main approaches; the band-aid approach (short term fix) and the long term approach. I am not a psychiatrist, so I will not be covering medication treatment.

Short Term Approach: This is the band-aid solution. This is not to say that it's the wrong way to do it, this is simply for when you're actually in the moment, and you have to just deal with the panic itself. The most effective tool to deal with a panic attack in the moment, in my opinion, is diaphragmatic breathing. This is a very specific breathing technique that focuses on bringing oxygen to your belly instead of your chest. When most people breathe, their chest expands, which limits the amount of oxygen we can take in. It is also quite common that when people try to breathe through their chest during a panic attack it exacerbates the panic attack. This occurs because often people will feel tight in their chest during panic attacks and attempting to breathe fully through the chest can feel challenging, which makes the person believe they are not getting any oxygen in; causing them to panic more. To utilize diaphragmatic breathing, take your hand and place it on your stomach. You inhale through your nose, and you try to fill up your stomach with as much air as you possibly can. Follow the air from your nose, past your chest, down into your stomach until you look bloated. Hold it for a few seconds, and then blow out from your stomach. You should be able to feel your stomach retracting to its normal position and do that repeatedly until you start to calm down. Remember: we're trying to stay away from expanding the chest. The reason for this is that is one of the major symptoms of the panic attack is tightness in the chest, heart racing, and feeling like you can't breathe. So, if you focus on the chest, you're going to start obsessing about the chest. So instead, with diaphragmatic breathing, you will focus on the stomach.

Long Term Approach: The long term approach involves ways to attack the panic attack head on so we can ultimately overcome it. The first part is just educational. You have to realize that unless you have a very severe medical issue, (which you could clear with your doctor), a panic attack is not dangerous to you. It can't actually hurt you, it just feels extremely dangerous. As much as you feel like you're in danger, you're actually not in any danger. And that's the biggest problem, right? Because that is what sends people into the panic in the first place; the feeling of doom, threat, danger or death. So, you have to remind yourself, when that panic attack comes, this is going to be really uncomfortable, but this will pass. Remind yourself “I'm not in actual danger, I'm not in actual threat, I'm not going to die.” Sometimes that alone can fix the problem. Once you realize that, now you just have to deal with the symptoms.

Now you might ask, well how do we deal with the symptoms? We do this with what is called exposure therapy. Exposure therapy is essentially gradually exposing yourself to things that you're fearful of over time, so that your body can adjust to the fearful stimulus and therefore is no longer frightened by the stimulus. Now, there's two elements in the panic attack that we must address. The first element is the feared object. This would be the thing that triggers the attack (outdoors spaces, spiders, heights, etc). The other element of the panic attack is the fear of the panic attack symptoms. And again, this is often what causes the panic attack disorder. People become afraid that they're going to have another one, so they become fearful of the sensations. So, what we need to do is get comfortable with the sensations. We need to get comfortable with the discomfort. We do this by gradually exposing yourself to those sensations, in a more comfortable environment, so when it’s time to face them in real time, you are ready for them and eventually immune to them. You should practice this along with your therapist so you know what you are ready to handle. Do not try this if you are not currently in therapy: Sit in a comfortable room with no distraction. Imagine the sensations you typically feel when you have a panic attack; let them arise within you. Notice the sensations and sit with them. Don't let them run away yet. Don't push them away. Be with them. Be curious. Check in with your heart rate. Check in with the tingling in your legs and your feet. Check in with the tingling sensation in the back of your neck. Check in with the uncomfortable sensation in your stomach or the lump in your throat. Whatever the sensations are, notice them. Don't judge them. And again, remind yourself, they are NOT dangerous. They are JUST UNCOMFORTABLE. The feelings WILL PASS. Over time you will get more and more comfortable with these uncomfortable feelings. You’ll be able to tell yourself, “I know this feeling. It's uncomfortable, but I know I can manage it.” As you get more comfortable with the symptoms, you will start to feel braver, and you will no longer avoid the things that trigger you because you won’t be afraid of what could happen. You won’t see the symptoms as a threat anymore. As the symptoms turn from signs of danger to simply sensations in your body, you will begin to realize you don’t need to check or obsess over them, and eventually will find the freedom to live your life fully and freely.